On initial assessment of his symptoms and signs, it was evident that they were consistent with a pathology that was gastrointestinal in nature. Taking into consideration his age, it was necessary to include gastro-oesophageal reflux disease (GORD) as a possible diagnosis. Most frequently seen in infants aged 1 to 4 months old, GORD clinically presents with recurrent regurgitation or vomiting, feeding issues, and failure to thrive¹. However, as his signs and symptoms were more severe; which included increasing frequency of vomiting, projectile vomiting and abdominal distension, other diagnoses that had a similar presentation needed consideration, such as pyloric stenosis, and necrotizing enterocolitis (NEC).
In terms of patient investigations, the initial work-up involved carrying out pertinent blood tests, which included a full blood count, urea and electrolytes, glucose, C-reactive protein, as well as a blood culture. NEC frequently demonstrates non-specific signs; neutropenia, elevated CRP levels and glucose instability, amongst others. Electrolyte imbalances (hypokalaemia and hypochloremia) are commonly seen in pyloric sten...
... middle of paper ...
...t paediatrician was uncertain about the diagnosis. He dealt effectively with this issue by seeking the opinions and advice from fellow paediatric consultants, registrars and radiologists. I had the opportunity to sit in for one of the x-ray meetings where the case of HG was discussed amongst medical professionals. It was evident that in the context of working as a multi-professional team, the medical staff understood and respected the role that each healthcare professional played in order to come up with a management plan that best served the interests of the patient.
The ultimate plan was to transfer HG to a hospital in Edinburgh with the intention of undergoing further tests and investigations. Following general principles of patient management, his parents were provided with an explanation, and given reassurance and support by the medical team in charge of HG.
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